It Starts and Ends with People

In a recent site visit to Shasta Community Health Center for Spreading Solutions That Work, I was struck by the way people use behavior change theory and might not even realize it.

I studied health and social behavior in grad school and was up to my eyes and ears in individual behavior change theory and how to use it in designing public health interventions. Behavior change is complex, and requires identifying and analyzing determinants of health behaviors. I remember finding this topic fascinating, yet since then, I’ve admittedly wondered at times if I should’ve studied something more “practical” like health management. Anyway, over the course of my years in the health field, I’ve been delighted to find that the application of behavior change theory shows up in my work in many ways, though doesn’t look as academic as I remember from school. I’d bet many of you reading this will find these connections in your work as well.

This site visit was focused on patient portal optimization. Many health centers are figuring out how to drive volume to patient portals to modernize operations and give patients the kind of access to their care and health information that they desire. A key takeaway from this visit was the importance of getting clinician champions on board to use the patient portal and promote it. An engaged clinician champion can be the spark that starts a wildfire of momentum around technology use.

As we heard about this tactic and spoke to the clinician champions using the portal, I realized that there are parallels with social diffusion theory, which refers to a process in a social system where an innovative idea or concept is spread by members of the social group through certain channels. A well-known application of this theory is the Popular Opinion Leader intervention for HIV prevention, which involves enlisting and training key opinion leaders to encourage safer sexual norms and behaviors within their social networks. To me, that sounds pretty similar to identifying a clinical champion to message the importance and value of a change amongst their peers.

This got me thinking – How else might we already use behavior change in our work? When investigating how to best implement change in an organization, we often first evaluate where people are in terms of readiness for change, then create a plan based on that. That draws from the transtheoretical model of behavior change, which is a framework for understanding how individuals and populations progress toward adopting and maintaining health behavior change. As we encourage improvement teams to incorporate observation in their data collection, we’re infusing elements of social cognitive theory, recognizing that observational learning has tremendous value.

Whether we’re talking about care delivery transformation, adopting new technologies, or creating a culture of quality improvement within an organization… at the end of the day it starts with people and behavior change for groups of people. Similarly, many of these efforts end or stagnate when we don’t consider the human element involved in implementing change. So, while I wouldn’t suggest throwing around academic jargon to inspire change in an organization, for me, it’s good to have in my back-pocket yet another reason to prioritize the human aspect of change when trying to improve our health system.